All posts by CHOC Children's

Physician Wellness: Benefits of Gratitude

CHOC Physician Wellness Subcommittee Update
by Dr. Grace Mucci, Pediatric Neuropsychologist

Physician burnout is prevalent. According to the Mayo Clinic, up to 54% of doctors report at least one symptom of burnout. Further, it is estimated that the annual cost of that burnout is $4.6 billion per year in the form of physician turnover and reduced clinical hours, according to a study recently published by the Annals of Internal Medicine.

The experience of burnout results in feelings of cynicism, detachment from work, low sense of personal accomplishment, and emotional exhaustion. The reasons for burnout remain complicated, and a recent systematic review by the Journal of the College of Physicians and Surgeons Pakistan revealed both individual characteristics of physicians and variables within the working environment as contributory factors.

More specifically, work load appeared to be one of the main drivers and includes working hours, overnight duty, administrative duties, schedule and flexibility, and complexity of tasks. Feeling disconnected from colleagues or patients, poor communication or cooperation between colleagues and dealing with patients who disagree with treatment choices are additional sources of burnout.

Just as the causes of physician burnout are multi-factorial, the solutions encompass many strategies that include engaging in various lifestyle changes and systemic interventions.

One individual intervention that has been receiving more interest among researchers is gratitude. A 2017 study at UC Berkeley shows that the health benefits of expressing gratitude include increasing resilience to stress and boosting mental health. Gratitude also has been found to strengthen relationships and enhance mindfulness.

So, just how can we implement gratitude in everyday life? Here are a few ideas that can be applied easily:

  • Express gratefulness for the beauty in nature
  • Give thanks before eating food that has been prepared
  • Acknowledge service people you encounter throughout the day, such as a barista or worker
  • Keep a gratitude journal and write about all the things you’re thankful for prior to retiring for the night
  • Remember to tell your loved ones how much they are appreciated and one thing that you are grateful that they do every day
  • Surprise coworkers or even strangers by performing a random act of kindness
  • Keep a gratitude board where you document things you are thankful for, and be sure to review those items when you are having a difficult moment

At CHOC, several initiatives that promote this practice of expressing gratitude are underway. CHOC has partnered with the Institute for Healthcare Excellence (IHE) to offer an outstanding curriculum that helps build respect, trust and compassion, ultimately improving communication and empathy toward co-workers and patients and restoring joy to the practice of medicine.

In addition, CHOC’s Physician Wellness Subcommittee is busy planning a Wall of Gratitude in the physician dining room, where doctors can show gratitude and appreciation for their peers in real time.

We know that peer-to-peer recognition is important for strengthening the level of engagement and positive bonds among colleagues. We have all experienced the satisfaction of receiving kudos from our peers, and we want to make this easier and more visible to others. As we continue to advance these initiatives, be sure to practice those small but powerful strategies of expressing gratefulness in your everyday life.

Increasing Performance Excellence at CHOC: Meet Sharon Nielsen Wilson

CHOC Children’s has tapped a seasoned healthcare leader to further increase performance excellence across the pediatric healthcare system.

In her role as executive director of performance excellence, Sharon Nielsen Wilson will find ways to improve and enhance how CHOC patients and families are served across the organization at all levels. Further, Sharon is tasked with facilitating, understanding and supporting change throughout the organization.

“I am thrilled for this new opportunity at CHOC, and I look forward to building upon a strong culture of service and performance excellence to help propel CHOC forward as it strives to become the destination for children’s health,” Sharon said.

Sharon Nielsen Wilson, executive director of performance excellence

Bringing a clinical background as well as a dozen years of experience in improving systems and workflows, Sharon joined CHOC in May 2019 from Kaiser Permanente. She began work there in 2006 as a registered nurse and most recently served as director of performance improvement for its facility in Harbor City, Calif.

Sharon holds a bachelor’s degree in nursing from California State University, Dominguez Hills, and is currently pursing a master’s degree in quality assurance. She is also certified in change management through Implementation Management Association (IMA) and quality insurance through CSUDH.

We caught up with Sharon recently to learn more about her role and what she hopes to accomplish at CHOC.

What is Quality Improvement and why is it important to a healthcare organization?

Quality Improvement (QI) is a proactive and systematic approach to improve processes and systems.

QI models present a systematic, formal framework for establishing QI processes in your practice. Understanding and properly implementing QI is essential to a well-functioning practice and is necessary for improving efficiency, patient safety or clinical outcomes.

Examples of common QI models include:

  • IHI’s Model for Improvement: Thismodel uses plan-do-study-act (PDSA) cycles to test interventions on a small scale. The model combines two popular QI models: Total Quality Management (TQM) and Rapid-Cycle Improvement (RCI).
  • Six Sigma: A method of improvement that focuses on reducing variation.
  • Lean: An approach that reduces waste by decreasing non-value-added work in systems and processes.

How can all CHOC associates take an active role in improving performance excellence?

Associates can take an active role by taking advantage of the certification programs and partnership CHOC’s Performance Excellence team will be offering beginning this fall and together effectively identify, plan and execute improvement projects, deliver successful results and spread changes across the entire system.

The certification programs Performance Excellence will be offering are tailored to each level in the organization. The programs will help build a more solid foundation of knowledge and skills in the art and science of improvement within CHOC.

What do you see as key performance strengths for CHOC – and how can we build upon them to further enhance how we serve patients and families?

I see our associates’ engagement and dedication to CHOC’s mission as some of key performance strengths here at CHOC. Some ways to build on these strengths is to invest in our workforce and infuse performance excellence into our culture. As we continue to build reliability and efficiency into our processes and systems, we will be able to remove frustration and the potential for error and add value to the way we serve one another, our patients and their families.

Causes and Treatment for Pain Amplification Syndrome

Andrew Shulman, MD, PhD, pediatric rheumatologist at CHOC Children’s, discusses the causes and treatment for this common yet complex condition.

1) What is pain amplification syndrome?

Pain amplification syndrome is a condition (not a disease) in which patients develop an abnormal pain sensitivity. The nervous system registers and processes normal sensations from movement and environmental experience as pain signals. Think of the nervous system as an electronic sensor: The sensor has a detection threshold. All signals with an intensity level below the threshold are perceived as “normal” and all signals above the threshold are “pain.” In children with pain amplification syndrome, the threshold is too low. Normal sensations and movements cause the nervous system to experience pain.

2) What are the causes?

We need to understand much more about what causes pain syndromes, experience over time with many patients with this condition reveals some common triggers. Joint flexibility is the most common cause of musculoskeletal pain in children, and is often responsible for what is known as “growing pains.” Patients with pain amplification syndrome often have flexible joints and have previously experienced joint and muscle discomfort. Some patients have had numerous orthopedic injuries in the past, or a particular traumatic injury that causes pain sensitivity in one part of the body.

In some patients, emotional trauma, psychological difficulties or psychiatric conditions can trigger pain sensitivity. In most patients, sleep is affected and is not restful. Even when psychological factors are not an initial cause, the stress from experiencing pain and the resulting disruption in school and activities can amplify pain sensitivity. We don’t know enough about the genetics of pain perception, but children with pain amplification syndrome commonly have family members with pain difficulties.

3) What are the symptoms?

Symptoms include body aches, joint and muscle pain, abnormal sensations of burning, tingling, numbness or pressure, headache, and chronic abdominal pain. In some cases, light touch to the skin causes pain sensations. Accompanying features include “dysautonomia,” wherein the autonomic nervous system does not perfectly regulate blood flow throughout the body. This results in symptoms of Raynaud’s phenomenon (cold sensitivity of the hands and feet with color changes, numbness, tingling and burning) and dizziness, particularly when standing up. These symptoms are not dangerous but can be uncomfortable and worrisome to patients.

4) What are the treatments?

A number of therapies work together to reset the abnormal pain sensitivity. Physical activity, particularly aerobic exercise, is very important in normalizing the pain threshold. Therapeutic massage can desensitize the nervous system and help the patient feel touch and movement as normal and not painful. Developing a regular, restful sleep schedule is important.

Finally, psychological therapy is often a critical aspect of the therapeutic program. This therapy is focused on stress management and coping techniques. In some cases, medications that decrease nerve signal transmission can be used. These medical treatments only assist the other therapies and are generally not effective in children when used alone.

5) What kind of testing is involved?

No laboratory or imaging tests can confirm the diagnosis of pain amplification syndrome. The diagnosis can be difficult to establish because numerous other medical conditions could potentially cause the symptoms. It’s important to take a step back and look at the “big picture” of a patient’s history and symptoms. Patients commonly have extensive investigations with many specialists before reaching a pain amplification syndrome diagnosis. Physicians with experience in pain amplification syndrome can help recognize the condition. Rheumatologists often help because they are familiar with symptoms and diagnostic challenges posed by autoimmune and inflammatory diseases.

6) Is there a cure?

Pain amplification syndrome is not a disease, so no cure is needed. This is a condition that patients learn to manage and control.

7) What can patients and families expect when treating pain amplification syndrome?

Families can expect more good days and fewer bad days as patients work through the abnormal pain sensitivity. The overall trend is gradual recovery, which can be measured by regular school attendance and activity participation. Reassurance that the patient does not have a serious disease often provides a big boost as the therapeutic program moves forward.

8) How bad does pain have to get before you see a pediatric rheumatologist?

Patients should be evaluated when symptoms become a significant concern and affect school attendance or participation in sports and activities. Pediatricians and subspecialty colleagues should seek rheumatologists’ expertise for help evaluating a pain amplification syndrome diagnosis and/or making treatment recommendations.

For questions or more information, please contact Andrew Shulman, MD, PhD, pediatric rheumatologist at CHOC Children’s, at 714-509-8617. 

In the Spotlight: Rishikesh Chavan, M.D.

CHOC welcomed Dr. Rishikesh Chavan to the oncology department in January 2019. As the Medical Director of the Stem Cell Transplant and Cellular Therapy program, he works with young patients going through leukemia, lymphoma or other conditions requiring bone marrow or stem cell transplants. He attended medical school at Lokmanya Tilak Municipal Medical College in India, followed by a pediatrics residency at Tulane University School of Medicine and a Hematology/Oncology fellowship at Baylor College of Medicine. Subsequently, he served as the Medical Director of Stem Cell Transplant at Tulane University and Loma Linda University Children’s Hospital.

Dr. Rishikesh Chavan, Oncology

What are your special clinical interests?

Stem cell transplant and immunotherapy for high risk leukemias/lymphomas. I am also interested in reduced intensity stem cell transplants and gene therapy for immunodeficiencies, aplastic anemia and sickle cell disease patients.

What are some new programs or developments within your specialty?

Comprehensive whole patient care model involving psychology, nutritionists, social workers, child life specialists, pharmacists and care coordinators as an integrated team approach to improve the ease of transition between inpatient and outpatient care, to ensure patient satisfaction and compliance, and to achieve best possible outcomes—all while lowering the cost of care.

What would you most like community/referring providers to know about you or your division at CHOC?

We believe every patient coming to transplant deserves personal attention, and we strive to over-communicate with the referring providers to share updates about their patients’ health as well as
facilitate with transitioning the patients back to the referring providers as soon as the patients are ready to be followed by them.

What inspires you most about the care being delivered here at CHOC?

Healthcare delivery is going through a transformation, and CHOC is at the forefront of this healthcare transformation by bringing the latest evidence-based treatments as well as clinical trials to benefit our kids while simplifying the care they need.

If you weren’t a physician, what would you be and why?

I would be a farmer. I feel it is a skill that requires patience, selflessness and long-term thinking, and that the efforts put in by one generation are likely to benefit the next generation.

What are your hobbies/interests outside of work?

I volunteer at the local library to facilitate a Heartfulness Meditation group (a network of volunteer meditation coaches and a meditation app). I also like to spend time with my kids and dog at the park. When time permits, I try to go to the gym and play tennis. I also read a lot—nowadays audiobooks.

What have you learned from your patients?

Resilience. Given the patients we have, I can never really have a bad day. If I do feel I’m having a bad day, my patients’ situations give me perspective.

CHOC Children’s Hospital honored with resuscitation recognition award

CHOC Children’s Hospital has received the Get With The Guidelines®-Resuscitation Silver Plus Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer cardiac arrests in the hospital.

More than 200,000 adults and children have an in-hospital cardiac arrest each year, according to the American Heart Association. The Get With The Guidelines-Resuscitation program was developed with the goal to save lives of those who experience in-hospital cardiac arrests through consistently following the most up-to-date research-based guidelines for treatment. Guidelines include following protocols for patient safety, medical emergency team response, effective and timely resuscitation (CPR) and post-resuscitation care.

“This recognition is more evidence of CHOC Children’s steadfast commitment to the highest standards of patient care,” said Dr. Jason Cook, a pediatric critical care physician and medical leader of CHOC’s resuscitation activities. “We’re grateful to have the American Heart Association’s Get With The Guidelines-Resuscitation program as another resource in CHOC’s toolbelt to ensure the best possible outcomes for our patients.”

CHOC received the award for meeting specific measures in treating pediatric in-hospital cardiac arrest patients. To qualify for the awards, hospitals must comply with the quality measures for two or more consecutive years.

“CHOC is dedicated to helping our patients have the best possible outcomes and ensuring they have happy and healthy childhoods,” said Dr. James Cappon, CHOC’s chief quality officer. “Participating in the American Heart Association’s Get With The Guidelines-Resuscitation program helps us accomplish this by making it easier for our teams to put proven knowledge and guidelines to work on a daily basis.”

“We are pleased to recognize CHOC for their commitment in following these guidelines,” said Lee H. Schwamm, M.D., national chairperson of the Quality Oversight Committee and Executive Vice Chair of Neurology, Director of Acute Stroke Services, Massachusetts General Hospital, Boston, Massachusetts. “Shortening the time to effective resuscitation and maximizing post-resuscitation care is critical to patient survival.”

Get With The Guidelines-Resuscitation builds on the work of the American Heart Association’s National Registry of Cardiopulmonary Resuscitation originally launched in 1999 and has collected in-hospital cardiac arrest data from more than 500 hospitals. Data from the registry and the quality program give participating hospitals feedback on their resuscitation practice and patient outcomes. In addition, the data helps improve research-based guidelines for in-hospital resuscitation.

About Get With The Guidelines

Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program that provides hospitals with the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines has touched the lives of more than 6 million patients since 2001. For more information, visit heart.org.